Don't punt the public option debate to the states

From desmoinesdem at MyDD here.

Supporters of this compromise assume that very few states would opt out, because the public health insurance option is so popular. Alternatively, some people argue that even if a lot of red states opt out, blue states will reap economic benefits, while Republican politicians at the state and federal level are put in an awkward position.

There's no question that enacting some kind of nationwide public health insurance plan with an "opt-out" would give far more Americans access to the plan than Carper's "opt-in" proposal.

However, my concern is that quite a lot of states might ditch the public health insurance plan. Corporate interests have at least as much influence over state legislatures as they do over Congress--perhaps more. The public option would particularly benefit residents of states with little to no competition in the private health insurance market. But Representative Bruce Braley (IA-01) seems on target in warning that states with "strong political influence from one or two major health insurance companies" would be most likely to opt out, leaving "consumers in those states without a meaningful choice."

Daily Kos user eugene argues here, "Not only is this a bad idea because of the policy and political costs of throwing 'red states' overboard, it dramatically understates the very real risks that even so-called 'blue states' would choose the opt-out." Click through to read his case.

This Huffington Post piece points out another reason to be wary:

"One problem with the opt-out idea is that Republicans may seize on it in the future and turn it into a general opt-out for states to exempt themselves from the whole bill," said Paul Starr, health care expert at Princeton University. "Remember there will be four years and two elections before the reforms go into effect. This would be the easiest step for Republicans take during that period to ensure that the whole thing would unravel. And it would unravel because states that adopted the reform would become magnets for migration by the sick from states that opted out."

Punting the public option choice to the states might squeeze a few extra votes out of the Senate, but at what cost? Passing a more comprehensive bill with just 51 votes in the Senate, using the budget reconciliation process, seems more promising than obtaining 60 votes for an opt-out.

In related news, Senator Chris Dodd promised yesterday to "fight for a strong public option" when he works with Majority Leader Harry Reid and Senate Finance Committee Chairman Max Baucus to merge the bills passed by the HELP and Finance committees. Senator Sherrod Brown of Ohio and 29 other Senate Democrats sent Reid a letter this week supporting a public option "available continuously in all parts of the country."